Capgras Syndrome

Capgras and Reboul-Lachaud (1923) refer to a condition now known as the Capgras syndrome, in which an individual believes that a familiar person, usually a spouse or a child, has been replaced by a double or an imposter.

This condition occurs in schizophrenia Opens in new window, but also in toxic and brain-damaged cases (Hayman and Abrams 1977; MacCallum 1973). Christodoulou (1977) reported a series of psychotic cases in which EEG abnormalities were common.

Among organic patients, frontal and temporal lobe pathology, has been reported with a suggestion of a right hemisphere bias.

The Capgras syndrome seems to occur in the context of a depersonalization state with a loss of object familiarity. In some respects, it is a delusion within a “negative autoscopy,” a delusion built around the failure to recognize the most familiar objects.

However, it is unclear whether such patients have a disturbance of self-recognition (i.e., “mirror sign”). However, in the Capgras phenomenon the failure in recognition is associated with delusion or confabulation, and in this way differs from the mirror sign.

The Capgras phenomenon and the mirror sign illustrate the close relation between perception, hallucination, and delusion. A disturbance at an early stage in object formation affects an object in relation to its affective or experiential content.

The image of the self is affected (mirror sign), or highly familiar and emotionally charged objects, because they have a strong affective and symbolic value.

The disturbance in the object is accompanied by a confabulatory element. Confabulation may invade the mirror image and lead it to be identified as a close relative, or close relative may become imposters or doubles.

In such cases, the confabulation — or the delusion — points to a prelexical conceptual phase in language production, just as an hallucination points to an image phase in object formation.

One can say that an hallucination is the perceptual form taken by a delusion when it (the delusion or confabulation) was previously the cognitive element in a defective object. This is why in psychotics we say that thoughts objectify in hallucinations.

The hallucinations captures the delusional thought which previously involved an object which was only beginning to break down. A delusion is a transitional stage in object breakdown prior to hallucination. In senile patients, it is often difficult to distinguish between delusion and hallucination unless the subject actually reports “seeing” the described experience.